As of March, I've been blessed to be insured again. That said, I've seen a lot of doctors while playing catch up.
I saw the sleep apnea doctor who immediately prescribed an updated study. So I spent a night at St. Joseph's and discovered that not only did I need a new machine. But it was also set to DOUBLE the air pressure setting I had been on for years. NO WONDER I've been so tired. My energy level has been improved tremendously since then. Thank you, Dr. Siler!
My goal is to be able to eliminate the need for the CPAP machine AND the blood pressure and possibly even cholesterol medications.
What is Roux En Y Gastric Bypass?
The surgeon sections off a small piece of the upper stomach, a pouch that has a capacity of about a tablespoon. It can stretch comfortably to hold two ounces of food and that amount of food creates a "full stomach" feel. This is the "restrictive" component of gastric bypass surgery.
The "bypass" part of the operation occurs when surgeon, at a point about 18-24 inches below the beginning of the small intestine, divides the intestine. He then moves the lower piece of the small intestine up to connect with the new stomach pouch. Bypassing most of the original stomach and two to five feet of the small intestine does not cause significant malabsorption of nutrients from food. However, vitamins and iron are taken into the body through this now bypassed first part of the intestine. Therefore, gastric bypass patients must take multivitamins with iron every day.
After the stomach pouch and the stoma, or opening into the intestine, have been created, the upper part of the small intestine is reconnected to the small intestine that receives the food and is going downstream. Why? So the stomach and pancreatic juices and bile salts that normally travel down this upper intestine can be available for processing the food in the intestine.
Now then...........back to JULY!
So on July 12th I made the trek back to Des Peres. This time for the dietary consult and the psych eval. I had to take another day off! My mom has been managing me by seeing to it that I follow up on these appointments. I thought she retired? HA HA. No matter how old you are, I suppose mom's never retire from being moms?! Anyhooo.....so like a good daughter, I call mom to let her know I've been a good girl and scheduled my follow up (from the endoscopy on 6-12). And she says to me, "I may be able to drive my van by then" (it had been in need of a minor repair). I say to her, "well, mom, this appointment won't require me to have someone else drive me home.". So she reaches to feel needed by saying, "I thought you might like someone to go with you.". I say, "Well mom, if you want to go, you can go with me........." (not wanting to exclude her). And she JUMPS on it and replies, "GOOD, cos I have LOTS of questions!". Mind you, this is the same woman who in 1995 would slip me brochures for breast reduction slipped in with mail or papers she'd hand me from time to time. When I eventually relented and had that surgery, she has the audacity to tell the surgeon during pre-op, "take it ALL, I don't want her to have to come back and do this again!!!". She totally gave my boobs away! WTH?! What was she going to tell this doctor???
I took yet another day off for the half day run of appointments: dietary consultation, follow up appointment and psychiatric evaluation.....and I DREADED them. I was most wigged out about the psych eval. I was sure they were going to tell me I was bat shit crazy!!!
Turns out it was a walk in the park. I appreciated Dr. French's years of practice alongside bariatric physicians. He walked me through the surgical procedure and was sure to go over the positives and negatives of it. I learned that the data is starting to come back with regard to lap band surgeries (like I initially had in 2006). More than half the patients are ending up having them removed after all....due to various reasons. And based on some of my mom's questions, I learned that with the bypass I can expect to lose about 75-80% of my "excess weight" (the number of pounds I am over weight) in the first year. For me, that means I should expect to lose 150-160 lbs by the one year mark. Can't.Even.Imagine. Then, he says, it may take the next few months to drop the last 20%.
One of the ugliest things I've heard and he reiterated about the post surgery expectations is a little complication called "dumping syndrome". I've had the whole lap band throwing up. And I have IBS so I'm used to having to run to the bathroom at times. But what I didn't expect to hear is that after surgery, due to the way they have to re-reroute your organs, I may not have control of so called syndrome. In layman's terms that means I can get diarrhea and it can creep up so fast that I may not have any warning or make it to a bathroom. So expect "accidents". This WILL happen if I eat things I'm not supposed to eat, like items high in sugar. LAWD, give me the willpower to avoid such things so I do not have to suffer the embarrassment of shitting myself in public!!!! This is one thing that scares the living hell out of me. Other than that, it sounds very much like some side effects of the lap band minus certain food restrictions. Unlike the band, I'll be able to eat steak again. But I'll share all those types of details with you as I get underway.
One thing that the dietitian and the psych doctor asked about was my support system. Apparently this is PARAMOUNT to success. I was sure to tell them I had a huge, loving and supportive family and group of friends. So I am not at all concerned about this.
Next up, I saw the dietitian. She asked me some questions and took the time to get familiar with my lifestyle. This will help her understand what my personal challenges are and how to guide me from there. Together we made some short and long term goals. Mine were:
Short Term:
- Substitute one soda per day with iced tea
- Try to eat breakfast at least 3x per week
Long Term:
- To be able to walk a 5k
- To reach a healthy weight
Dietary Guidelines I was given:
- 3 day pre-operative diet
- diet progression: clear liquids 1 wk post op, full liquids wk 2 post op, soft foods week 3 post op and solid foods by week 4 post op. YIKES. I remember I HATED this part after the lap band!!!
- Lifelong supplements: Multivitamin with Iron
- Calcium with Vitamin D
- B12
- Protein Supplements
Lifestyle & Behavior Modifications:
- Measure portion sizes 1/2-1 cup
- 3 meals per day
- Take 15-20 min to consume a 1/2 cup but no longer than 30 min
- Chew food to a toothpaste consistency
- Do NOT eat and drink at the same time, stop drinking 30 min before meals and wait till 30 min after a meal to drink again
- Choose foods low in fat and sugar
- Limit caffeine
- Limit alcohol
- Avoid carbonated beverages
- Avoid drinking through a straw
- Avoid gulping and guzzling liquids
- Avoid foods that cause gastric disturbances
Exercise:
- Cardio (walking, biking, swimming)
- Muscular strength (free weights, exercise bands, machines)
- Flexibility (stretching, yoga, pilates)
Follow Ups:
- 1 wk post op
- 1 month post op
For now, the good news is that according to all the testing Dr. Scott did, including the endoscopy, he found no reason to be concerned with proceeding with the surgery. He found nothing on the Endo. And my blood work showed no enzymes that indicate a predisposition to blood clotting disorders. My check list was down to ONE last item.....a surgical clearance from my primary care physician/internist.
Last Friday I met with Dr. Murray who gave me the GREEN light for surgery. It was nice that he already had copies of the results from all the tests Dr. Scott's office had taken. Dr. Murray simply wanted to run another Thyroid panel, as my levels were still high. He was referring to my TSH level, Thyroid Stimulating Hormone. It is high because it has to work over time to keep my thyroid in check. I have Hypothyroidism. So I have to be sure to take my meds all week then run up to have another blood draw on Friday. That will determine whether or not they need to adjust my current thyroid meds.
Ironically, Dr. Scott's office emailed me just today indicating they wanted another panel taken, as well. At least they are on the same page. I can just go once and they will share the results. Once those are in, the next step is for Dr. Scott's office to submit everything to CIGNA for approval. By law, the insurance company has 30 days to approve or deny. My doctor's office says Cigna has been running 2 weeks. Once approval comes in, surgery can typically be scheduled within 2 weeks.
Aside from the last bit of blood work, I'll be working on the list below of "What should I do to get prepared for surgery?"
- Research everything about the surgery: Support Groups, Twitter, Daily Strength, Obesityhelp, Bariatric Bad Girls Club, Bariatric TV, etc
- Make Weight Loss Friends to get support from those who have been there, done that.
- Add more exercise to your day
- Lose some weight (cut back on simple carbs, up protein, practice post op lifestyle)
- Drink more water!
- Eliminate Soda and Smoking
- Figure out what made you overweight, what your eating issues are, what your trigger foods are, etc
- Take measurements and pictures
- Journal, blog etc..........
Thanks for following along, for ALL the words of encouragement I've already received and always for your friendship.
I look forward to the day I can blog again telling you that insurance has approved me!!!
Lori
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